Call 949-757-1188
4030 Birch Street, Suite 103
Newport Beach, California 92660
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Customer Survey
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Customer Survey
Participant
Name
First
Last
Email address
*
Please rate the following aspects of our work.
1. Was it easy to schedule a convenient appointment ?
Very Good
Good
Neutral
Poor
Very Poor
2. Were you greeted in a prompt and friendly manner ?
Very Good
Good
Neutral
Poor
Very Poor
3. Was your waiting time in the reception area reasonable ?
Very Good
Good
Neutral
Poor
Very Poor
4. Were your questions answered courteously and fully by the representative ?
Very Good
Good
Neutral
Poor
Very Poor
5. How would you rate the cleanliness of the clinic ?
Very Good
Good
Neutral
Poor
Very Poor
6. Was your doctor sensitive to your needs ?
Very Good
Good
Neutral
Poor
Very Poor
7. Did your provider make efforts to include you in decisions about your treatment ?
Very Good
Good
Neutral
Poor
Very Poor
8. Was your acupuncture treatment satisfactory ?
Very Good
Good
Neutral
Poor
Very Poor
9. Would you return or recommend our clinic for treatment ?
Very Good
Good
Neutral
Poor
Very Poor
10. How would you rate your overall experience ?
Very Good
Good
Neutral
Poor
Very Poor
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